Individual provider Active NPI

Kelly Jean Martin, M.A. CCC-SLP

  • Speech-Language Pathologist
  • Cedar Rapids, IA
National Provider Identifier
1871878645
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
002121 Issued in IA
Practice address
5264 Council St NE
Cedar Rapids, IA 52402-2471
Phone
(319) 929-0500
NPI assigned
Oct 12, 2011
Last updated
Sep 28, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 002121 IA Primary

Addresses

Primary practice location

5264 Council St NE
Cedar Rapids, IA 52402-2471

Mailing address

5264 Council St NE
Cedar Rapids, IA 52402-2471
Phone (319) 929-0500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181228001223 IA Practitioner - Qualified Speech Language Pathologist 1759626468 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
002121IAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Brandhorst Speech Therapy Speech-Language Pathologist CurrentSince May 16, 2024 Accepting new patients

Locations

1355 Sherman Rd
Ste 501
Hiawatha, IA 52233
Phone (319) 350-5468

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1871878645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5264 COUNCIL ST NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524022471",
            "telephone_number": "319-929-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5264 COUNCIL ST NE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524022471",
            "telephone_number": "319-929-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KELLY",
        "middle_name": "JEAN",
        "credential": "M.A. CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-12",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "002121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.